Medical Marijuana

The use of herbal cannabis is associated with reductions in self-perceived insomnia severity, according to data published in the online, open-access journal Medicines.

University of New Mexico researchers assessed the influence of marijuana use on self-perceived insomnia severity levels in 409 subjects. Study participants recorded real-time ratings of their symptom severity on a zero to 10-point scale using a mobile software application.

Authors reported that subjects “experienced a statistically and clinically significant improvement (-4.5 points on a zero to 10-point scale) in perceived insomnia levels. However, products made with C. sativa were associated with less symptom relief and more negative side effects than products made from C. indica or hybrid plant subtypes.” They added, “CBD potency levels were associated with greater symptom relief than were THC levels.”

Researchers concluded: “[O]ur results show that consumption of cannabis flower is associated with significant improvements in perceived insomnia with differential effectiveness and side effect profiles. The widespread apparent use of cannabis as a sleep aid underscores the importance of further medical research regarding its risk-benefit profile and the effectiveness of cannabis as a substitute for other substances, including alcohol, over-the-counter and prescription sleep aids, and scheduled medications (e.g., opioids and sedatives), many of which are used in part as sleep aids.”

Full text of the study, “Effectiveness of raw, natural medical cannabis flower for treating insomnia under naturalistic conditions,” is available online here.

Oklahoma health officials on Wednesday will discuss a series of revised rules and regulations to govern the state’s voter-approved medical cannabis access program. The newly proposed changes eliminate several restrictive amendments enacted by the Department earlier this month. The proposed changes come just days after the state’s Attorney General warned health officials that they “acted in excess of their statutory authority” when they amended State Question 788.

Specifically, the newly proposed rules — which are available online here — remove the ban on the retail sale of herbal cannabis, eliminate the requirement that dispensaries hire state-licensed pharmacists, and no longer mandate that women of childbearing age undergo a pregnancy test prior to receiving a medical cannabis recommendation. No such restrictions initially appeared in State Question 788.

Other proposed changes would remove arbitrary limits on the THC content of medical cannabis products, and permit dispensaries to sell cannabis plants and seedlings to qualified patients.

The changes, approved Tuesday in a 5 to 4 vote by directors at the Department of Health, seek to severely limit patients’ access to a wide range of cannabis products. Specifically, the new provisions: prohibit the sale of herbal cannabis at licensed dispensaries; require dispensaries to have a licensed pharmacist on staff; impose arbitrary THC potency thresholds on various cannabis-infused products; and mandate that dispensary managers obtain at least four hours of continuing education training each calendar year. Qualified patients will still be permitted to grow their own medical marijuana flowers.

The Oklahoma State Medical Association, which opposed the passage of SQ 788, lobbied for many of the amendments. Governor Fallin also was a vocal critic of the initiative campaign.

NORML Deputy Director Paul Armentano criticized the changes. “Government officials are not acting in good faith. Not only are they undermining the will of the voters, but they are violating the spirit of the law in a manner that will be detrimental to the very patients this measure was intended to protect.”

NORML has long argued that patients should not be limited solely to non-inhaled forms of cannabis because these alternative formulations possess delayed onset and their effects are far less predictable than those of herbal cannabis. Further, restricting patients’ access to herbal cannabis limits their exposure to the multitude of synergistically acting therapeutic compounds and terpenes found naturally in the plant, many of which are no longer present in formulations produced following the extraction of individual cannabinoids.

The enactment of medical cannabis access laws is associated with significant reductions in prescription opioid use among Medicaid enrollees, according to just-published data in the journal Addiction.

Investigators with the University of California at San Diego assessed the relationship between medical cannabis legalization and opioid use among Medicaid enrollees over a period of 21 years (1993 to 2014).

Authors reported, “For Schedule III opioid prescriptions, medical cannabis legalization was associated with a 29.6 percent reduction in number of prescriptions, 29.9 percent reduction in dosage, and 28.8 percent reduction in related Medicaid spending.” This correlation remained after authors controlled for potential confounders, such as the establishment of prescription drug monitoring programs and variations in patients’ income.

By contrast, authors did not report similar changes in enrollees’ use of Schedule II opioid drugs, like Oxycodone. Authors speculated that this result may be because physicians are more reticent to recommend medical cannabis options to these patients.

They concluded: “In this study, we found that statewide medical cannabis legalization implemented in 1993-2014 in the US was associated with close to 30 percent reductions in Schedule III opioids received by Medicaid enrollees.. … It was estimated that, if all the states had legalized medical cannabis by 2014, Medicaid annual spending on opioid prescriptions would be reduced by 17.8 million dollars.”

Their findings are similar to those of numerous other observational studies – such as those here, here, and here – finding that medical marijuana regulation is correlated with reductions in overall opioid-related use, drug spending, abuse, hospitalization, and mortality. Separate data evaluating prescription drug use trends among individual patients enrolled in state-licensed medical marijuana programs is consistent with this conclusion, finding that many subjects reduce or eliminate their use of opioids following enrollment.

The abstract of the new study, “Medical cannabis legalization and opioid prescriptions: Evidence of US Medicaid enrollees during 1993-2014,” appears online here.

Legislation to significantly expand patients’ access to medical cannabis will become law later this fall following a decision today by Maine lawmakers to override the Governor’s veto.

By a vote of 119 to 23 in the House and 25 to 8 in the Senate, lawmakers rejected Gov. Paul LePage’s veto of LD 1539. The bill will become law 90 days after the conclusion of the 2018 legislative session.

Under the new law, physicians will possess the discretion to recommend cannabis for any patient for whom they believe it will benefit. It also expands the total number of licensed medical dispensaries from eight to 14, earmarks funding for medical marijuana research, permits caregivers to oversee multiple patients, and licenses marijuana extraction facilities, among other changes.

An estimated 42,000 patients are currently certified with the state to use medical marijuana.

Republican Gov. Paul LePage has a long history of opposing virtually all marijuana law reform legislation, and has previously vetoed numerous bills seeking to liberalize the state’s cannabis policies.